Claims Processing Specialist

Responsibilities

Under the supervision of the Business Services Supervisor, the Claim Edit Follow-Up Representative is responsible for processing the electronic claims edits, “front end “edits, as well as claims edits from secondary claims. In the event a claim edit does not pass, the Follow-Up Representative must determine the required action and steps necessary to resolve the claim issue. The Claim Edit Follow-Up Representative will be expected to review and resolve a No-Activity Workfile / Workqueue, which consist of accounts that have no payment or rejection posted on the account and follow Kelsey-Seybold Clinic Central Business Office policies and procedures to determine the appropriate action. The representative will be expected to follow up with daily workloads and also be able to meet work standards and performance measures for this position

Job Title : Claims Processing Specialist

Location : Pearland Administrative Office

Department : BOfc-PrAuth&Clm Edit

Job Type : Full Time

Salary Range : $39,179 – $48,397 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

Qualifications

Education

Required :  High School diploma or GED

Preferred :  Additional training as a medical office assistant, medical claims processor, or medical claims follow

up specialist.

Experience

Required : Minimum of 3 years billing experience, knowledge of healthcare business office functions and their

relationships to each other. (i.e. billing, collections, customer service, payment posting) and insurance

products such as managed care, government and commercial products.

Preferred : Three or more years’ experience in a healthcare business office setting, preferably in electronic

claims billing, or insurance follow up.

License(s)

Required :  N / A

Preferred :  N / A

Special Skills

Required :  Must be familiar with laws and regulations governing Medicare billing practices, medical billing

systems, and claims processing.

Preferred :  IDX / EPIC, PC skills, and understanding of billing invoice activity such as credits, debits, adjustments,

contractual agreements, etc.

Other

Required :  N / A

Preferred :  N / A

Working Environment :   Office

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work / life balance by joining our team today and changing the way health cares.

Why Kelsey-Seybold Clinic?

• Medical, Vision, and Dental
• Tuition Reimbursement
• Company Matching 401K
• Employee Reward and Recognition Program
• Paid time off for vacation, sick, and holidays
• Employee Assistance Program
• Continuing Medical Education allowance

Claims Processing Specialist